On Dec. 19, 2013, claimant Ruben Berton, 57, a contractor, underwent laparoscopic, robot-assisted, hiatal hernia repair. The procedure was performed by Dr. Hugo Barrera, a genera surgeryl surgeon, at Sharp Chula Vista Hospital, in Chula Vista. Berton had a postoperative bleeding complication that extended his hospitalization and caused to his lungs. Berton sued Barrera; a nurse that allegedly administered too much morphine for pain, Gonzalo Hernandez, and Sharp Chula Vista Medical Center. The matter ultimately went to arbitration, in lieu of a jury trial, with Barrera as the only respondent. Berton’s counsel contended that Barrera violated the standard of care by performing the surgery, given Berton’s reported history of ingesting medications that could have affected the ability of his blood to coagulate. Counsel also contended that Barrera failed to order Berton’s return to surgery at 1 p.m. on Dec. 20, 2013, instead of at 4 p.m. that day. Barrera’s counsel asserted that the surgery was indicated and consented to by Berton and that Berton reported to Barrera that he had taken ibuprofen within two days of the surgery, which was not a contraindication to performing surgery. Counsel also contended that there was no indication of abnormal bleeding at the time of the surgery or in the immediate post-operative period that would have been suggestive of a coagulopathy. Defense counsel further contended that it was after Berton was administered Lovenox as prophylaxis against deep vein thrombosis that signs and symptoms, in retrospect, suggested that he may been having a postoperative bleeding complication from the surgery. In addition, counsel asserted that Barrera took a reasoned, stepwise approach to addressing Berton’s condition. The defense’s expert general surgeon, who specializes in laparoscopic surgery, opined that Berton was an appropriate candidate for the proposed surgery and that Barrera’s pre-operative work up of Berton exceeded the standard of care. The expert also opined that there was no contraindication to performing the surgery based upon the information that Barrera received from Berton regarding ibuprofen and naproxen, as any effect on platelets from those medications would have dissipated within 24 to 48 hours. Further, the expert testified that he did not believe that any medication ingested pre-operatively had any impact on Berton and that if the medication ingested two days before surgery was responsible for the post-operative bleeding complication, Barrera would have noticed abnormal bleeding at the time of surgery. In addition, the general surgeon testified that he believed that, in retrospect, to a reasonable degree of medical probability, the post-operative bleed was caused by the Lovenox and that it would have been below the standard of care to not give the patient Lovenox. The defense’s general surgery expert opined that Barrera complied with the standard of care for a general surgeon in taking Berton back to surgery when he did and that returning Berton to surgery any sooner would have subjected Berton to more risk than waiting, in that it was prudent to give Berton blood products to stabilize his blood pressure and blood values, and see if he improved. He also testified that post-operative bleeding complications are common in this type of surgery and often resolve without the need to return to surgery. Lastly, the general surgery expert testified that returning Berton to surgery at 1 p.m., rather than 4 p.m., made no difference in his post-operative course and that Berton would have still needed blood products, been intubated and had the same course. The defense’s emergency medicine expert, who is a medical toxicologist, testified that the ibuprofen that was reported to Barrera does not have an antiplatelet aggregation effect after approximately 24 hours and that ibuprofen consumed more than 24 hours in advance of surgery does not increase the risk of bleeding. The expert also opined that ibuprofen did not cause the bleeding experienced by Berton and that there was no evidence that Barrera was advised that Berton consumed aspirin. Instead, the expert opined that Lovenox significantly contributed to the bleeding., Due to the post-operative bleeding complication, Berton’s lungs collapsed and were found to contain liquid. Berton claimed that he now suffers a long-standing decrease in lung capacity with related fatigue, pain, and poor health. He also has to use medicine and an inhaler due to his lungs injury. He further claimed that he experiences ongoing pain in his chest, back and kidney area while breathing. Berton alleged that due to his injury, he lost his ability to perform many of his duties and activities that he once performed prior to the incident. Specifically, he had to cut his working hours short because he could no longer go to the office to take care of the daily responsibilities as a small business owner, which created great financial harm. He was also unable to properly complete two of his projects and gain new clients. In addition, Berton had to eliminate many of his leisure activities. Berton sought recovery of medical costs, lost earnings, and damages for his past and future pain and suffering. His wife, Marisela Berton, sought recovery for her loss of consortium. In the plaintiffs’ statement of damages, they requested $5 million.